Man becomes Hawaii’s first patient to request lethal prescription drug

John Radcliffe became the first Hawaii patient with terminal cancer to request a lethal prescription to end his life under the state’s new medical-aid-in-dying law.

The longtime lobbyist and poster child for Hawaii’s Our Care, Our Choice Act, which took effect on Tuesday, has far outlived the six-month prognosis for his terminal cancer diagnosed in June 2014. He is preparing for his 72nd round of chemotherapy next week and says he is generally pain free, but wants to have the medication available as an end-of-life option.

“You may never pick it up, you may never need it, you may never actually use it. What it is, primarily, is an anxiety-reducing element in an otherwise very stressful situation,” said Radcliffe, 76, at a news conference Wednesday with state officials and supporters of the program. “My end-of-life experiences so far have been … very interesting and it’s not at all unpleasant. There isn’t any doubt chemo’s keeping me alive. I’m grateful to be alive. As you can plainly see I love life. But I know my life is going to end soon.”

The controversial program faces a number of hurdles with few doctors and pharmacists willing to prescribe the medication. Access to the lethal drug also is limited because of manufacturing issues and soaring drug prices. In addition, the state faces a challenge in monitoring the poisonous drugs once they are dispensed in the community.

“This is poison. These are large doses of very potent drugs so we are still in the process of developing guidance to families and guidance to pharmacies on the proper safekeeping and storage of this medication. … So that curious kids or other folks who may think these are opioids that maybe have some street value (don’t get them),” said Lorrin Kim, chief of the state Department of Health Office of Planning, Policy and Program Development. “An accidental poisoning risk is a concern. Nothing’s ever foolproof.”

The DOH is exploring policies that include requiring “extremely conspicuous labeling,” Kim said.

“You’re going to have a hundred pills of this stuff in your house for an average male. We’re concerned about someone finding the pills,” he added. “They’re bright red pills so they’ll look that much more attractive to little kids.”

The Health Department is recommending medical- aid-in-dying patients enroll in hospice care, which can help monitor the drugs in homes and properly dispose of them.

The DOH projects as many as 40 to 70 patients will seek medical aid in dying this year. There are about 10,500 deaths annually in the islands.

Patients deemed mentally capable and able to take the medication on their own will be able to request a lethal prescription after two doctors confirm the terminal illness and six-month prognosis. Patients must make two separate appeals for medication, with a 20-day waiting period between the first and second requests. Also required is a written request overseen by two witnesses, one of whom is prohibited from being a beneficiary of the patient’s estate. It is a criminal offense to tamper with a patient’s request or to coerce someone into medically assisted death.